 ACS Committee on Trauma Presents Injuries Due to Burns and Cold Injuries Due to Burns and Cold

 ACS Objectives  Estimate size of injury and determine associated injuries  Discuss the principles of initial assessment and treatment  Identify special problems and methods of treatment  Specify criteria for transfer of burn patient

 ACS Key Questions: Burn Injury  What should I do first?  How do I identify inhalation injury?  How do I estimate burn size and depth?  What is the rate and type of fluids administered to a burn patient?  Who do I transfer to a burn center?

 ACS What should I do first? Assess the patient’s ABCDE and stop the burning process

 ACS Burn Management Principles Establish and Maintain  Airway and Breathing  Normal perfusion (C and D)  Fluid and electrolyte balance (C)  Normal body temperature (E)

 ACS Identify inhalation injury? Carbonaceous sputum Face and neck burns Inflamed oropharynx and hoarseness Carbon deposits Hair singeing CO Hgb > 10%

 ACS Manage airway / breathing?  Assume: Direct thermal or inhalation injury  Establish and maintain patent airway early and consider early ET intubation  Oxygenate and ventilate  Obtain ABGs and CO levels

 ACS Adequate organ perfusion?  Adequate venous access  Monitor vital signs  Hourly urinary output  Adult: 0.5 – 1.0 mL / kg / hour  Child: 1.0 mL / kg / hour  Infant: 2.0 mL / kg / hour

 ACS Estimate burn size and depth? Palm + fingers = approximately 1% BSA Rule of Nines Infant 9% 13% 2.5% 7% 4.5% 9% 4.5% 18% 1% 7%

 ACS Second-degree Burn

 ACS Third-degree Burn

 ACS Rate and type of fluids?  4 mL warmed Ringers lactate / kg / % BSA in 1 st 24 hours  Administer ½ in 1 st 8 hours  Administer ½ in next 16 hours  Base on time from injury  Monitor heart rate and urinary output

 ACS What history do I need?  AMPLE history  Tetanus status

 ACS Other management?  Baseline blood analyses and chest x-ray  Gastric intubation  Narcotics  Antibiotics  Wound care  Flow sheet documentation

 ACS Manage chemical burns?  Determine type, duration, amount, and concentration  Brush away dry chemicals  Special consideration for specific chemicals Flush with copious amounts of water for 20 – 30 minutes

 ACS Manage electrical burns?  Fascia and muscle damage, may spare overlying skin  Myoglobinuria:  Fluids, mannitol  Maintain adequate perfusion  Sodium bicarbonate Fasciotomy

 ACS Whom do I transfer? Second- and Third-degree Burns  > 10% BSA in ages 50 years  > 20% BSA (all ages)  To unique areas (any size burn)  Face  Eyes  Ears  Hands  Feet  Genitalia  Perineum  Major joints

 ACS Whom do I transfer?  Third-degree burns > 5% BSA (all ages)  Electrical and chemical burns  Inhalation injury  Preexisting illnesses, associated injuries  Children  Special situations

 ACS Transfer procedures to use?  Coordinate with burn center doctor  Transfer with  Documentation / information  Laboratory results

 ACS Key Questions: Cold Injury  How does cold affect my patient?  How do I recognize a cold injury?  How do I treat local cold injuries?  How do I treat a systemic cold injury?

 ACS How does cold affect? Cold Injury Factors  Immobilization  Moisture  Vascular disease  Open wounds  Temperature  Duration of exposure  Environmental conditions

 ACS Recognize local cold injuries?  Frostnip  Frostbite  Nonfreezing

 ACS Treat cold injuries?  Do not delay  Remove clothing  Warmed blankets  Rewarm frozen part  Preserve damaged tissue  Prevent infection  Elevated exposed part  Analgesics, tetanus, and antibiotics

 ACS Recognize hypothermia?  Rapid or slow drop in core temperature to < 35  C  Elderly and children at greater risk  Low-range thermometer required

 ACS Recognize hypothermia? Clinical Findings  T C < 35  C  Depressed level of consciousness  Gray, cyanotic  Variable vital signs  Absence of cardiorespiratory activity

 ACS Treat hypothermia?  ABCDEs  Rewarm  Assess for associated disorders  Blood analyses, including K + and Ca ++

 ACS Treat hypothermia?  Passive, external rewarming: Warmed environment, blankets, and IV fluids  Active core rewarming: Surgical rewarming techniques  Do not delay transfer  Not dead until warm and dead

 ACS

Summary: Burn Injury  Recognize and treat inhalation injury  Fluid resuscitation  Identify burn injuries requiring transfer

 ACS Summary: Cold Injury  Diagnose type  Measure core temperature  Rewarming techniques  Monitor and support vital functions